4 Myths About Assisted Outpatient Treatment

AOT is court-supervised treatment of severe mental illness within the community. It is a 2-way commitment that requires mental health systems to serve participants at the same time it commits participants to adhere to their treatment plans. "In December the [APA] Board of Trustees approved a position statement that directs our ongoing advocacy efforts on involuntary outpatient commitment (IOC)/assisted outpatient treatment . . . The APA position is that IOC/AOT can be a useful intervention for patients with severe mental illness and documented histories of poor compliance leading to repeated relapses and rehospitalizations. It can be effective when accompanied by adequate resources and intensive, individualized outpatient services and when the initial commitment period is 180 days." -Renée Binder, MD: Assisted Outpatient Treatment: APA’s Position Statement. Psychiatric News

This argument has been soundly rejected in the courts. In the 2004 case Matter of KL, the plaintiff challenged Kendra’s Law, arguing it authorized “forced treatment” without adequate due process. The New York Court of Appeals, widely regarded as a champion of civil liberties, unanimously held that AOT is not forced treatment. The court noted Kendra’s Law prohibits forcible administration of medicine and only allows re-hospitalization if the usual commitment criteria are met. Thus, the court found the law relies on “the compulsion generally felt by law abiding citizens to obey court directives,” not force. [See Reference 12 here]

This misconception ignores the key factor addressed by AOT-anosognosia. Approximately half of individuals with serious mental illness experience anosognosia, damage to the parts of the brain used to think about ourselves, confirmed by at least 20 studies. [See Reference 13 here] People who think nothing is wrong with them-the signature symptom of anosognosia-have no reason to seek treatment. It is simply illogical to assume system improvements will draw in these patients, and the experience of many communities unfortunately bears this out.

There is simply no defensible evidence that this is true. In fact, when individuals receiving AOT under Kendra’s Law in New York were asked, 81% said AOT had helped them get and stay well.[See Reference 14 here]

Research shows that the population served by AOT disproportionately uses public resources. Consequently, research has found that mental health services, including voluntary services, can actually be expanded when AOT is used because of savings associated with decreased resource utilization by a small population.[See Reference 15 here] More broadly, addressing the outsized costs associated with high utilization is a growing concern for public health and policymakers.

For more on this topic, see Assisted Outpatient Treatment Enters the Mainstream, on which this slideshow is based.